MEDICARE: MATTHEW SMALLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03439555	OH

General Provider Information

NPI Number	:	1518562404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW SMALLEY

Provider Business Mailing Address
First Line	:	7301 LAKE SHORE BLVD
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-3029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 LAKE SHORE BLVD
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-3029
Country	:	US
Telephone Number	:	440-602-6071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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Directions to “ MATTHEW SMALLEY ” Practice Location

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